Non-traumatic intramural hematoma of the duodenum—a case report—

Abstract

We report a case of non-traumatic duodenal intramural hematoma. A 48-year-old male complaining of vomiting was referred to a local doctor and then admitted to our hospital. At the time of admission, his blood pressure was low. Blood gas analysis revealed remarkable metabolic alkalosis. Abdominal computed tomography showed marked expansion of the stomach and an approximately 6×8cm inhomogeneous tumor at the second and third portions of the duodenum. Upper gastrointestinal series revealed duodenal stenosis. Stenosis was thought to be due to a submucosal occupying lesion. MRCP revealed sclerosis of the main pancreatic duct. The common bile duct was slightly dilated and the intra-pancreatic bile duct was stenotic, though no irregular change of the bile duct wall was recognized. Therefore, we diagnosed a duodenal gastrointestinal tumor of the duodenum. One month after admission, he underwent pancreaticoduodenectomy. The resected specimen showed an intramural hematoma arising from the duodenal muscularis propria. Severe atrophy and fibrosis were recognized in parenchymal pancreatic tissue. Thus, the pathological diagnosis was intramural hematoma of the duodenum with chronic pancreatitis. Heavy drinking and chronic pancreatitis may have been causal factors in our case. Non-traumatic adult cases such as our patient are rare. The preoperative diagnosis of hematoma allowed surgery to be avoided in our case. Thus, preoperative diagnosis is clearly important.